Healthcare Provider Details

I. General information

NPI: 1861522245
Provider Name (Legal Business Name): RONALD J TADDEO MD,, PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PHYLLIS DR SUITE H
PATCHOGUE NY
11772-2900
US

IV. Provider business mailing address

4 PHYLLIS DR SUITE H
PATCHOGUE NY
11772-2900
US

V. Phone/Fax

Practice location:
  • Phone: 631-447-7560
  • Fax: 631-447-7561
Mailing address:
  • Phone: 631-447-7560
  • Fax: 631-447-7561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number123293
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier123293
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerHIP
# 2
Identifier222095432
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUBH
# 3
Identifier095041
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVALUE OPTIONS EMPIRE
# 4
Identifier0071438
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerVALUE OPTIONS GOVERNMENT
# 5
Identifier222095432
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCIGNA
# 6
Identifier66F592
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerEMPIRE
# 7
IdentifierP563956
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD
# 8
Identifier3105845
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI BMP
# 9
Identifier222095432
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerAETNA
# 10
Identifier008700400
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: